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      Ecologists can enable communities to implement malaria vector control in Africa

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          Abstract

          Background

          Integrated vector management (IVM) for malaria control requires ecological skills that are very scarce and rarely applied in Africa today. Partnerships between communities and academic ecologists can address this capacity deficit, modernize the evidence base for such approaches and enable future scale up.

          Methods

          Community-based IVM programmes were initiated in two contrasting settings. On Rusinga Island, Western Kenya, community outreach to a marginalized rural community was achieved by University of Nairobi through a community-based organization. In Dar es Salaam, Tanzania, Ilala Municipality established an IVM programme at grassroots level, which was subsequently upgraded and expanded into a pilot scale Urban Malaria Control Programme with support from national academic institutes.

          Results

          Both programmes now access relevant expertise, funding and policy makers while the academic partners benefit from direct experience of community-based implementation and operational research opportunities. The communities now access up-to-date malaria-related knowledge and skills for translation into local action. Similarly, the academic partners have acquired better understanding of community needs and how to address them.

          Conclusion

          Until sufficient evidence is provided, community-based IVM remains an operational research activity. Researchers can never directly support every community in Africa so community-based IVM strategies and tactics will need to be incorporated into undergraduate teaching programmes to generate sufficient numbers of practitioners for national scale programmes. Academic ecologists at African institutions are uniquely positioned to enable the application of practical environmental and entomological skills for malaria control by communities at grassroots level and should be supported to fulfil this neglected role.

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          Most cited references104

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          The global distribution of clinical episodes of Plasmodium falciparum malaria.

          Interest in mapping the global distribution of malaria is motivated by a need to define populations at risk for appropriate resource allocation and to provide a robust framework for evaluating its global economic impact. Comparison of older and more recent malaria maps shows how the disease has been geographically restricted, but it remains entrenched in poor areas of the world with climates suitable for transmission. Here we provide an empirical approach to estimating the number of clinical events caused by Plasmodium falciparum worldwide, by using a combination of epidemiological, geographical and demographic data. We estimate that there were 515 (range 300-660) million episodes of clinical P. falciparum malaria in 2002. These global estimates are up to 50% higher than those reported by the World Health Organization (WHO) and 200% higher for areas outside Africa, reflecting the WHO's reliance upon passive national reporting for these countries. Without an informed understanding of the cartography of malaria risk, the global extent of clinical disease caused by P. falciparum will continue to be underestimated.
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            Malaria transmission in urban sub-Saharan Africa.

            The rapid increase in the world's urban population has major implications for the epidemiology of malaria. A review of malaria transmission in sub-Saharan African cities shows the strong likelihood of transmission occurring within these sprawling cities, whatever the size or characteristics of their bioecologic environment. A meta-analysis of results from studies of malaria transmission in sub-Saharan Africa shows a loose linear negative relationship between mean annual entomologic inoculation rates (EIR) and the level of urbanicity. Few studies have failed to find entomologic evidence of some transmission. Our results show mean annual EIRs of 7.1 in the city centers, 45.8 in periurban areas, and 167.7 in rural areas. The impact of urbanization in reducing transmission is more marked in areas where the mean rainfall is low and seasonal. Considerable variation in the level of transmission exists among cities and within different districts in the same city. This article presents evidence from past literature to build a conceptual framework to begin to explain this heterogeneity. The potential for malaria epidemics owing to decreasing levels of natural immunity may be offset by negative impacts of urbanization on the larval ecology of anopheline mosquitoes. Malaria control in urban environments may be simpler as a result of urbanization; however, much of what we know about malaria transmission in rural environments might not hold in the urban context.
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                Author and article information

                Journal
                Malar J
                Malaria Journal
                BioMed Central (London )
                1475-2875
                2006
                3 February 2006
                : 5
                : 9
                Affiliations
                [1 ]Department of Zoology, University of Nairobi, Nairobi, Kenya
                [2 ]City Medical Office of Health, Dar es Salaam City Council, Dar es Salaam, United Republic of Tanzania
                [3 ]Department of Zoology and Marine Biology, University of Dar es Salaam, Dar es Salaam, United Republic of Tanzania
                [4 ]Rusinga Island Child and Family Programme/Christian Children's Fund-Kenya, Rusinga Island, Suba District, Kenya
                [5 ]National Institute for Medical Research, Dar es Salaam, Tanzania
                [6 ]Japan International Cooperation Agency, Tokyo, Japan
                [7 ]National Library of Medicine, Washington, DC, USA
                [8 ]Entomology Unit, FAO/IAEA Agriculture and Biotechnology Laboratory, Seibersdorf, Austria
                [9 ]Laboratory of Entomology, Wageningen University & Research Centre, Wageningen, The Netherlands
                [10 ]School of Biological and Biomedical Sciences, Durham University, Durham, UK
                [11 ]Department of Geography, University of South Carolina, Columbia, South Carolina, USA
                [12 ]Ifakara Health Research and Development Centre, Ifakara, United Republic of Tanzania
                [13 ]Department of Public Health and Epidemiology, Swiss Tropical Institute, Basel, Switzerland
                Article
                1475-2875-5-9
                10.1186/1475-2875-5-9
                1409792
                16457724
                987023b8-8c87-4a10-b0c6-8a72fb59a0c6
                Copyright © 2006 Mukabana et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 12 November 2005
                : 3 February 2006
                Categories
                Opinion

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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